North Ayrshire Alcohol and Drug Partnership Delivery Plan 2015-2018

 
North Ayrshire Alcohol and Drug Partnership Delivery Plan 2015-2018
North Ayrshire Alcohol and Drug Partnership

               Delivery Plan
                2015-2018

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ADP Delivery Plan

1. Partner Organisations

The Following organisations have agreed to the development and formation of this plan:

   o   North Ayrshire Council
   o   NHS Ayrshire and Arran
   o   Police Scotland
   o   Scottish Fire and Rescue Service
   o   Third Sector Interface
   o   South West Scotland Community Justice Authority
   o   Recovery at Work (RaW) Committee
   o   Jobcentre Plus

2. Introduction

Alcohol & Drug Partnerships (ADPs) are responsible for developing local strategies to deliver improved core and local outcomes on
the basis of local need, and for making investment decisions to achieve these. They also have a key role in delivering the national
policy initiatives, The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem (2008) and Changing Scotland’s
Relationship with Alcohol: A Framework for Action (2009)

The North Ayrshire ADP Joint Strategic Commissioning Plan 2015– 2018 sets out the approach to tackling alcohol and drug related
problems and identifies some of the challenges we face in improving these outcomes for individuals, families and communities,
which the ADP has adopted a “whole population approach”. The ADP Delivery Plan reinforces this outcomes based approach to
measuring success through a diverse range of activity by our respective sub-group partners and wider stakeholders. The
overarching aim of the Delivery Plan is to support the population of North Ayrshire to build on their strengths.

The Delivery Plan defines what the ADP aspire to achieve over the next three years and the actions that are required to bring this
about. This includes increasing the emphasis on preventative spend, earlier intervention and diversionary activity, as well as on

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ensuring treatment and support services are person-centred and recovery orientated and have a greater focus on service user
engagement and peer support.

Each of the ADP sub-groups has a designated section within the Delivery Plan, along with ADP Committee, in order to demonstrate
a clear focus on the delivery of actions that contributes to the strategic priorities of Prevention, Protection, Recovery and
Communities, incorporating national and local outcomes, Ministerial priorities, Opioid Replacement Therapy recommendations and
local contribution to the Single Outcome Agreement. In addition, for each sub group, they will utilise national and/or local
performance data that indicates an initial baseline figure along with projected targets for the 3 year period, with a requirement to
provide an update within annual reports. Activity will be measured through a variety of qualitative and quantitative methods.

*A number of the national data indicators, available to the ADP, refer to several years ago and does not reflect the period of the
Delivery Plan.

In order to monitor ongoing progress, and to improve links between the ADP Committee and ADP sub-groups, each of the ADP
sub-group chairs will be members of the ADP Committee where they will be required to provide a quarterly summary report
demonstrating progress and highlighting areas for remedial action and resource allocation. In addition, there will be two newly
formed sub-groups incorporating Contract Management, and Financial Management, which will monitor the delivery of ADP funded
services.

In July 2013, all ADP’s received a Quality Improvement letter from the Scottish Government detailing that the quality improvement
framework is the focus of the next stage of delivery of the Road to Recovery and builds on recommendations within the Quality
Alcohol Treatment and Support report - making sure quality is embedded across all services in Scotland: Quality in the provision of
care, treatment and recovery services and quality in the data that will evidence the medium and long term outcomes of people in
recovery.

The alcohol and drug quality improvement framework aims to drive a culture of self-assessment and validation of services, whereby
ADPs will commission services based on evidence of meeting principles of care, which will be measured by a range of tools
including quality indicators of recovery.

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Quality principles, improved data and evidence, and planning and reporting requirements will all contribute to effective Recovery
Orientated Systems of Care (ROSC) across Scotland, where there is a clear need for an integrated approach to service planning,
commissioning, design and delivery.

As of April 2015, North Ayrshire ADP now operates within the North Ayrshire Health and Social Care Partnership (H&SCP)
framework with contribution to the Community Planning Partnerships (CPP) Single Outcome Agreement. As such there is a
requirement to work alongside and complement the overarching Strategic Plans 5 Priorities. The ADP will seek approval and
endorsement from the CPP/ H&SCP of the annual report detailing progress towards key strategic actions, prior to submission to the
Scottish Government.

3. Financial Investment

The funding letter to ADPs in 2014/15 highlighted that funding is conditional on demonstrating progress towards both national and
locally relevant alcohol and drugs outcomes and the delivery of Ministerial priorities.

Scottish Government provides earmarked funding to ADPs to help them deliver against agreed outcomes. While this funding is
routed for administrative purposes via NHS Boards, it is a partnership resource and the full allocation must be directed to ADP level
for decision-making, informed by robust needs assessment, and in line with recognised evidence base. Investment decisions
should be transparent and made on a partnership basis in pursuit of locally agreed strategies and delivery plans, which seek to
deliver nationally agreed core outcomes and local outcomes.

The 2015/16 budget allocation for North Ayrshire ADP was £658,613 (drugs) and £994,294 (alcohol). This represents a percentage
allocation from the Ayrshire and Arran Health Board of 38.99% (drugs) and 36.78% (alcohol), based on formulae’s being applied
from estimated prevalence data. Whilst there is an expectation for the ADP to project 3 year budgets this presents a challenge due
to the ADP only being in receipt of annual funding, which is not confirmed till after the start of each financial year. In addition, the
ADP recognise the issues around short-term funding and recruiting and maintaining staffing levels within commissioned services,
which may be detrimental in delivering towards targets.

Notwithstanding this matter the ADP had indicated a desire to invest in earlier intervention activity and this will be monitored
through the Financial Management sub group.

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4. NORTH AYRSHIRE ALCOHOL AND DRUG PARTNERSHIP: STRUCTURE (June 2015)

                                                 Community Planning Partnership
                                                                                              Violence against Women P’ship
    Safer North Ayrshire P’ship

                                                Health and Social Care Partnership
                                                                                                 Child Protection Committee
    Adult Protection Committee

                                           ALCOHOL AND DRUG PARTNERSHIP

                                              Strategic Management Team

    Recovery                   Contract       Finance and             Workforce      Communities &             Children
    Oriented                  Monitoring     Commissioning           Development       Prevention             Affected by
                                                                                         Group                 Parental
  System of Care                                                                                              Substance
                                                                                                                Misuse

                                                                                                     ADP Support
  Recovery at Work Committee

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The diagram provides details of the ADP framework, where a detailed plan for each of the sub groups is detailed within the Delivery
Plan

The ADP structure will be amended in the coming year through forming two separate sub groups of the Finance, Commissioning
and Performance Monitoring group. This will ensure the strategic priorities and key actions is fully being monitored within
appropriate group activity.

The ADP Committee will monitor the following actions to ensure there is a clear thread from strategic delivery incorporated within
sub group delivery plans.

5. ADP Committee

                                            ADP Committee- Strategy delivery & needs assessment
      We will take forward our vision that 'the harmful effects of alcohol and drug          Consider the number of services
       misuse in North Ayrshire are reduced' by ensuring a mix of services, actions, and       contributing towards national outcomes/
       influence, which are individually focussed on one or more of the seven national         align resources to reflect need
       core outcomes for ADPs, and which collectively address all seven of them
      We will ensure a fit with other HSCP strategic and tactical developments in            Liaising with H&SCP governance
       delivering our strategy at an operational level
      We will support the CPP emphasis on a neighbourhood approach to service                Consider demographics of client group and
       design and delivery and will ensure this is reflected in our progress, and will         delivery of services within the community,
       ensure we meet our HEAT Alcohol Brief Interventions (ABI) and ‘Access to                particularly engagement with the ‘hidden
       Treatment’ standards and Ministerial Priorities                                         population’;
      We will apply evidence from local research or from elsewhere if judged
       transferable to local circumstance, to improve services                                Consider needs assessment, Stakeholder
      We will work with partners to make sure that our activity in pursuing our outcomes      event feedback, service review, and profiles
       and vision around alcohol and drugs remains in harmony with wider aspirations
       for our community and society. We will have particular regard to how ADP               ADP sub group activity towards delivery
       services and activity matches and supports the five strategic priorities set by the     plans
       HSCP
      We will work with a wider set of partners and stakeholders via the HSCP, the
       CPP and beyond, to strengthen our capacity to advise and influence services not
       directed specifically at alcohol and drug issues, but where their operation does
       impact on those affected by such issues

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   We will work with partners and within the HSCP to develop synergistic influence
       on the widest set or resources to advance our objectives and vision
      We will ensure improved capacity within the lifetime of this strategy to analyse
       market performance and intervene where potential market failure threatens
       progress
      We will direct our resources on the basis of how existing and proposed services
       will impact against our seven ADP core outcomes, and on the degree to which
       they will operate in ways that support our guiding principles, all within the context
       of their resource requirement and likely ease of implementation
      We will use data on local needs to guide our work on gap analysis
      We will ensure that the ADP and its sub-groups are fully informed of changes to
       legislation, evidence or guidance so they might take proper account of these in
       their operational activities
      We will pursue the 7 core outcomes for ADPs set by the Scottish Government as
       our priority and address the four focus areas of prevention, protection, recovery
       and communities through our activities, but with the added emphasis as set out
       by our four guiding principles

      Senior Management will be signed up to reviewing the way services operate and
       are prepared to provide the necessary leadership to manage change

6. Finance Commissioning and Performance Monitoring (FCPM) sub- group

                                          Finance Commissioning & Performance Monitoring requirements
National Outcome(s)-

SERVICES: Alcohol and drugs prevention, treatment and support services are high quality, continually improving, efficient,
evidence-based and responsive, ensuring people move through treatment into sustained recovery

7 Ministerial Priorities
    Compliance with the Alcohol Brief Interventions (ABIs) HEAT Standard
    Increasing compliance with the Scottish Drugs Misuse Database (SDMD)
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 HEAT Drug and Alcohol Treatment Waiting Times Standard, including, increasing the level of fully identifiable records
       submitted to the Drug and Alcohol Treatment Waiting Times Database
      Increasing the reach and coverage of the national naloxone programme and tackling drug related death(DRD)/risks in your
       local ADP
      Implementing improvement methodology at local level, including implementation of the Quality Principles: Standard
       Expectations of Care and Support in Drug and Alcohol Services and responding to the recommendations outlined in the
       independent expert group on opioid replacement therapies
      Ensuring a proactive and planned approach to responding to the needs of prisoners affected by problem drug and alcohol
       use and their associated through care arrangements
      Improving identification of, and preventative activities focused on, new psychoactive substances (NPS)

Quality Principles- (August 2014) Standard Expectations of Care and Support in Drug and Alcohol Services

1. You should be able to quickly access the right drug or alcohol service that keeps you safe and supports you throughout your
recovery.
2. You should be offered high-quality; evidence-informed treatment, care and support interventions which reduce harm and
empower you in your recovery.
3. You should be supported by workers who have the right attitudes, values, training and supervision throughout your recovery
journey.
4. You should be involved in a full, strength-based assessment that ensures the choice of recovery model and therapy is based on
your needs and aspirations.
5. You should have a recovery plan that is person-centred and addresses your broader health, care and social needs, and
maintains a focus on your safety throughout your recovery journey.
6. You should be involved in regular reviews of your recovery plan to ensure it continues to meet your needs and aspirations.
7. You should have the opportunity to be involved in an ongoing evaluation of the delivery of services at each stage of your
recovery.
8. Services should be family inclusive as part of their practice.

Opioid Replacement Therapy Review (September 2013) – makes 12 Recommendations under the following six themes.
Theme 1: Social exclusion and health inequalities (Recommendations 1-2)
Theme 2: Opioid replacement therapies in Scotland (Recommendations 3-5)

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Theme 3: Progressing recovery in Scotland (Recommendations 6-7)
Theme 4: Governance and accountability of the delivery system (Recommendations 8-9)
Theme 5: Information, research and evaluation (Recommendations 10-11)
Theme 6: Mechanism for change (Recommendation 12)

Local Outcomes-

3 Single Outcome Agreement Priorities
     Worklessness
     Health inequalities
     Community safety

SOA (Healthy Priority)- People are healthier and experience fewer risks as a result of alcohol and drug use
   Increased Recovery Capital
   Reduced drug related deaths

Health & Social Care Partnership

Vision - All people who live in North Ayrshire are able to have a safe, healthy and active life

5 Strategic Priorities

      Tackling inequalities
      Engaging communities
      Bringing services together
      Prevention & early interventions
      Improving mental health and well-being

ADP Aim Statement (November 2013)
North Ayrshire ADP will increase the level of recovery capital by 15% by September 2016 for all discharged cases

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FCPM- Financial Management sub group
                                     Budget Management                                                          Evidence/ activity

   We will move ADP funded services, and influence wider policies and services impacting on             Tiered funding breakdown
    alcohol and drug issues, towards prevention
   We will act on the principle of investing any new or released resources in preventative or           Consider funding within Tiers 1 &
    earlier intervention services whilst ensuring safe and effective treatment support is available       2
    for those in greatest need
   We will fund path-finding and innovative services, where ADP funding would be time limited,
    and services that demonstrated their value would be commended for their improved impact              Consider project proposals
    to other service programmes                                                                           (through ADP sub groups)
   We will review ADP funding for all services as well as undertaking both an impact and                Consider H&SCP v ADP funding
    performance review of all services
   We will seek opportunities to use ADP resources either to draw in matched funding or as a
    catalyst to direct other resources to our objectives

                                           FCPM Service delivery & contract monitoring sub group

   We will either enhance and support the contract monitoring system, or establish a system
    linked to the contract monitoring process to better assess the impact of services (2)               1) Consider quarterly contract
   We will work with procurement and contract monitoring staff to strengthen our information              monitoring information and
    base on providers within this market and to identify any actions needed around                         provide feedback to services for
    development or diversification (1)                                                                     service development/
   We will ensure existing services, as well as any service proposals, are subject to such a              improvements
    scrutiny and appraisal process that we will design and implement within 3 months of                 2) Utilise the PBMA appraisal model
    adopting this strategy, so that their contributions to our strategic progress can be measured       3) Revised service specifications for
                                                                                                           all ADP funded services
    and compared. This will form the baseline for future commissioning decisions and activity
                                                                                                        4) Contract monitoring template will
    (2)                                                                                                    reflect national outcomes, local
   We will complete development of a comparative appraisal system that will inform decisions              indicators & Quality Principles for
    on what pattern and level of services will best deliver our priorities in future, which will form      each service, who will require to
    our forward commissioning strategy/plan and determine specific service design and                      evidence service activity and
    specifications (2)                                                                                     developments
   We will work with colleagues directly involved in service delivery across all sectors, with         5) Undertake service visits to review/
    contract monitoring and procurement colleagues, and with provider and service user

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representatives, to ensure the most suitable service specifications are applied to support         validate evidence
    our service development, and that purchasing systems and planning are effective in              6) Services require to present an
    matching service provision to those who will benefit most (3)                                      annual service plan to highlight
   We will ensure early progress on further work on service performance and impact (1) & (2)          service delivery that is reflective
   We will maximise the quality of services, and the positive difference they make to service         of ADP outcomes, indicators &
    users and the community, by forging clear links between inputs and outcomes for service            Quality Principles
    users and our community at every stage of service commissioning, though concept, design,        7) Services will undertake RCQ and
    specification, operation, management, self-monitoring and review, and external scrutiny and        quarterly reviews- demonstrate
    appraisal (1), (2), (3), (4), (5), (6), (7)                                                        partnership working through joint
   We will ensure that the National Quality Principles set out by the Scottish Government for         care plans and reviews;
    ADPs in 2014 establishing basic standards of care and expectations of service delivery are         signposting to services and
    embedded in service design and reconfiguration (1), (3), (4), (5), (6)                             mutual aid groups
                                                                                                    8) Tier 3 services to complete the
   We will work amongst partners to ensure care/treatment plans for service users properly set
                                                                                                       DCAQ tool in order to identify
    out personal outcomes that are matched to ADP core outcomes and wider social and health
                                                                                                       effective resource allocation
    policy agenda (4) & (5)
                                                                                                       reflective of service demands
   We will require those involved in service provision to demonstrate how and to what extent
                                                                                                    9) Risk matrix considered on a
    their activities and methods deliver against not only their service specifications, but more
                                                                                                       quarterly basis
    widely against our core outcomes and guiding principles, and also on their ability to develop
    a plan to extend their own capacity and improve performance, including on a joint working
    basis with other stakeholders (1), (4), (5), (6), (7)
   We will ensure that recovery is placed at the heart of treatment and support services, and
    that this Recovery Oriented System of Care (ROSC) offers a comprehensive menu of
    person centred options, is strengths based, supports people to live as well as possible in
    the presence or absence of challenges and focuses on well-being and quality of life over
    morbidity and deficits, includes peer recovery support, includes families and friends and
    other recovery allies, has an unwavering belief that positive change is possible for all and
    achieves desired outcomes through collaborative, effective and high quality service
    provision and partnership (4), (5), (7)
   We will ensure treatment services remain high quality, safe, sustainable and specifically
    focus on recovery, earlier intervention, and avoidance of relapse (1) & (5)
   We will pro-actively address how service users and those important to them are involved
    and empowered in service development and delivery, and how inequalities for them are
    reduced (1), (4), (5), (6)

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7. The ADP Recovery Oriented System of Care sub group (ROSC)

The ROSC are responsible for taking account of up to date evidence based recovery practices, identifying and implementing
effective recovery pathways between providers and to take action where gaps are identified. The group continually link current
service provision with new service opportunities that will enhance an individual’s recovery journey through creating links with
mainstream provisions within the community that supports social inclusion.

The sub-group work to ensure that individuals have access to the right interventions at the right time as not ‘one size fits all’, which
enables them to move through treatment into sustained recovery through providing a holistic approach to meet needs. The group
subscribes to an ecological model where various services can be accessed simultaneously in a non-linear, non-sequential method,
allowing patients and service users to be engaged with as many or as few services that they feel are required to support their
initiation and sustaining of recovery from alcohol or drug problems.

This will include interventions provided by the NHS, local authority and voluntary sector and also involve engagement with other
people in recovery, which may be through mutual aid groups or other forms of peer support.

The context of ROSC in North Ayrshire- Recovery is possible and at the centre of all services we provide. People will own their
own recovery and services will facilitate their recovery journey and people in recovery will support others along the path to recover.

Through regular service user and wider stakeholder engagement over the last 2 years the ADP asked what recovery means in
North Ayrshire. Based on all the feedback received we have developed a local working definition of recovery:

“Recovery from alcohol and other drug problems is a deeply personal journey which anyone is capable of embarking upon.
Recovery is something which you can do for yourself though rarely by yourself; it can involve the growth and development of
individuals, families and communities. Recovery is empowering and an exciting opportunity. For many, recovery is about ‘giving
something back’ to your community, to your family and to yourself. At its heart recovery is about improving quality of life,
progressing and moving forward at your own pace.”

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The ROSC supports, and has a direct link with the recently established Recovery at Work (RaW) committee – a constituted
community group of people in recovery where the RaW Committee Chair is a formal member of the ROSC sub group and ADP
Committee.

The ROSC acknowledges the key role that family/significant others can play and are encouraged to support the individuals’
recovery journey and to also be supported to access support provisions to meet their needs too.

ADP Sub Group (ROSC)Strategic Priority: Recovery & Communities
National Outcome(s):
   HEALTH: People are healthier and experience fewer risks as a result of alcohol and drug use: a range of improvements to
    physical and mental health, as well wider well-being, should be experienced by individuals and communities where harmful drug
    and alcohol use is being reduced, including fewer acute and long-term risks to physical and mental health, and a reduced risk of
    drug or alcohol-related mortality.
   PREVALENCE: Fewer adults and children are drinking or using drugs at levels or patterns that are damaging to themselves or
    others: a reduction in the prevalence of harmful levels of drug and alcohol use as a result of prevention, changing social
    attitudes, and recovery is a vital intermediate outcome in delivering improved long-term health, social and economic outcomes.
    Reducing the number of young people misusing alcohol and drugs will also reduce health risks, improve life-chances and may
    reduce the likelihood of individuals developing problematic use in the future.
   RECOVERY: Individuals are improving their health, well-being and life-chances by recovering from problematic drug and
    alcohol use: a range of health, psychological, social and economic improvements in well-being should be experienced by
    individuals who are recovering from problematic drug and alcohol use, including reduced consumption, fewer co-occurring
    health issues, improved family relationships and parenting skills, stable housing; participation in education and employment, and
    involvement in social and community activities.

Opioid Replacement Therapy Review
 Theme 1: Social exclusion and health inequalities (Recommendations 1-2).
 Theme 2: Opioid replacement therapies in Scotland (Recommendations 3-5)
 Theme 3: Progressing recovery in Scotland (Recommendations 6-7)

Ministerial Priority
Ensuring a proactive and planned approach to responding to the needs of prisoners affected by problem drug and alcohol use and
their associated through care arrangements

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Local Outcome(s)

ADP Aim Statement (November 2013)
 North Ayrshire ADP will increase the level of recovery capital by 15% by September 2016 for all discharged cases.

2015/16 Single Outcome Agreement- People are healthier and experience fewer risks as a result of alcohol and drug use
 Percentage of service users indicating an improvement in their recovery capital

Local Indicator:                                  Baseline    Target            Annual performance review (brief summary)    Metric
                                                                                                                             RAG
   Increase the level of recovery capital        • No data   • To be
    incorporating social capital, physical                    confirmed for
    capital, human capital and perceived                      2016/17
    community capital

In order to contribute to the above noted outcomes the ADP will aim to deliver-

   Services will be embedded in the local community for the purpose of enhancing the availability and support capacities
    of individuals, families, social communities, and other communities in recovery. This will be achieved through-

        o increasing the number of GP practices prescribing Opiate Replacement Therapy medication and the delivery of Alcohol
          Brief Interventions within priority settings;
        o creating a coordinated and tiered prescribing workforce with the care of service users provided according to their needs
          by an appropriate prescriber most able to meet their individual requirements;
        o working alongside the Third Sector Interface to identify service provision through their resource mapping exercise, in
          order to improving service users being signposted to community provisions for ongoing recovery support;
        o Complete the formal partnership pilot project with Alcohol Focus Scotland, taking account of the impact of alcohol on
          recovery, families and communities. We will consider responses from stakeholders and consider these findings within a
          whole population context
        o continue to deliver and increase the number of SMART Recovery groups in a number of community settings whilst
          assertively linking service users with wider mutual aid organisations and other services within the locality;

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o people in recovery becoming employed in the Public Social Partnership model;
       o The delivery of a Recovery Café within two locations
       o Capacity building courses will be delivered as a prelude to engagement within the Recovery at Work (RaW) Committee
       o Continue pilot of people in recovery co-facilitating workshops within Ayrshire College and supporting roll out across
         Ayrshire
       o engaging with Community Pharmacies in order to raise awareness of recovery activity and utilise them as a key asset in
         supporting people in to services/ community groups
       o linkage with transport providers in order to support people in recovery to access community provisions
       o Support services to promote their availability and accessibility through service base opening times and outreach provision

   Individuals, families, and communities have strengths and resources that serve as a foundation for recovery.
    Communities have responsibilities to provide opportunities and resources to address discrimination and to foster
    social inclusion and recovery. The ADP will aim to reduce the impact of stigma and inequality through delivery of the
    following activity-

       o promoting recovery through local radio stations, local and national press, ADP website, ADP recovery literature, social
         media, and people in recovery presenting at community events;
       o supporting the RaW committee to demonstrate positive achievements to their peers and act as Recovery Champions
         within the wider community;
       o The ADP will host a variety of stakeholder events, promoting positive recovery experiences to the communities
       o highlighting recovery initiatives to Elected Members
       o engaging with community organisations and employers to create volunteering, training and employment opportunities
       o raise awareness of the positive peer research methods taking place and contribution to Strategic Planning
       o involvement in the updated version of North Ayrshire Council Inequalities Strategy
       o consider feedback and responses to the Peoples Panel survey
       o supporting the RaW committee to ‘start up’ a social enterprise and support the local organisation for the national recovery
         walk 2015
       o supporting people in recovery to become involved in generic community groups

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   The ROSC sub group encompasses a diverse range of services and people in recovery representation, with joint
    working protocols between specialist and non-specialist statutory, 3rd sector and community groups from community,
    prison, hospital and residential settings. The ROSC offers a continuum of care, including pre-treatment, treatment,
    continuing care and recovery support. The ADP will ensure individuals have a full range of stage-appropriate services
    from which to choose at any point in the recovery process, and taking account of any other partners that can enhance
    the ROSC model, through delivery of the following-

       o Engaging within the Health and Social Care Partnership structure and ensuring contribution towards the Strategic Plan.
       o Regular communication to monitor the delivery of ADP and Core funded services, ensuring a consistent approach takes
         place in terms of delivery and monitoring
       o Utilising the wide range of expertise from the newly formed Integrated Addiction Service. The ADP recognises
         methadone treatment, including maintenance with adequately resourced wrap around support services, is where the
         evidence base lies in drug treatment
       o a weekly joint allocation and assessment process between tier 2 and 3 services in order to identify appropriate services
         to needs. The ADP aims to ensure that treatment is offered at the lowest point in the stepped care model. Where service
         delivery at earlier points fails to meet needs then the treatment should be moved to the next level up, and vice versa
       o assertive linkage between treatment services and communities of recovery, with joint reviews being conducted to support
         transitions
       o continue funding for the Methadone Cessation programme and to implement the learning by embedding as a core
         element within wider addiction service provision
       o The Alcohol Liaison Service within the general hospital will offer support and signpost service users and promote access
         to primary and community alcohol support services.
       o identifying strengths and needs through conducting quarterly recovery capital questionnaires and associated recovery
         care plans, with regular reviews
       o recognising individuals lifetime experience of trauma through emotional, physical, and sexual abuse
       o engaging with Ayrshire College and the Third Sector Interface in order to promote employability and mainstream
         education opportunities
       o Liaising with Money Matters in order to undertake financial assessments, debt and financial management support.
         Raising confidence and awareness within wider staff groups of changes within welfare reform and universal credit
       o improved collaborative working between Jobcentre Plus & addiction service in order to support those in receipt of
         benefits and engaging within tier 3 service delivery

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o ADP representation within the Community Justice Authority Throughcare Group, supporting pathways from prison to
         community
       o Support the implementation of the protocols between Criminal Justice Social Work services and Integrated Addiction
         Services
       o Effective partnership working between addiction and mental health services
       o Female Peer Research findings and recommendations will be considered by services. Service developments will be
         highlighted through contract monitoring and to the ADP Committee
       o Further develop the input from females trained as peer researchers to consider wider scope in order to support service
         development/ barriers to treatment
       o Ongoing support will be provided for those within homeless settings and effective linkage with addiction services.
         Services will support the Care and Share programme and look to extend this model within other areas
       o We will encourage physical activity participation through partnership working with KA Leisure and continued funding for
         the Fitba4U programme
       o Contribution to the Community Planning Partnerships 6 Neighbourhood Plans

   An important factor in the recovery process is the presence and involvement of people who believe in the person’s
    ability to recover; sources of hope, support, and encouragement. Through these relationships, people leave unhealthy
    and/or unfulfilling life roles behind and engage in new roles (partner, caregiver, friend, student, employee) that lead to
    a greater sense of belonging, empowerment, autonomy, social inclusion, and community participation. In recognition
    of the key role that families/ significant others offer to recovery, the ADP will ensure the following activities are
    promoted in order to enhance their engagement through-

       o Continue to engage and promote the services delivered by the Lighthouse Foundation and Scottish Families Affected by
         Alcohol and Drugs
       o Services will consider the families own needs and signpost to relevant type services, detailed above
       o Services will promote family engagement from the point of referral and encourage inclusion within recovery care plans
         and reviews taking place
       o Family members will be encouraged to provide their views on service delivery and areas for improvement
       o Training opportunities will be promoted to family members

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o Introducing family peer support meetings in the community through SMART delivery techniques
       o Continue to deliver weekly Family Support Groups within Kyle Addiction Unit

   North Ayrshire ADP has introduced the Recovery Capital Questionnaire (RCQ) within all addiction service providers,
    where all staff is trained in utilising the RCQ. The RCQ tool has been embraced by the ADP in order to evidence
    increased recovery capital for individuals and service providers that supports the ADP’s contribution to the national
    Aim Statement and Single Outcome Agreement.

       o The RCQ tool considers an individual’s strengths and assets, where key areas are reflected within the complementary
         recovery care plan, which is reviewed on a 12 weekly basis. These tools enhance a person centred approach where
         goals and aspirations are reflected and people are empowered to direct their own recovery. Services provide information
         within quarterly contract monitoring in how recovery capital has been increased.

          The RCQ is broken down into 4 sections consisting of-

                Section 1: Social capital- social capital embodies family and social relationships, intimate relationships, access to
                 sober outlets for leisure and recreation, relational roles, family rituals, emotional support and access to
                 opportunities
                Section 2: Physical capital- physical capital is understood as physical health, sleep and general hygiene, cessation
                 of drug hunger, housing, finances, access to transport and physical appearance.
                Section 3: Human capital- human capital includes self-esteem, efficacy and awareness, values and beliefs,
                 resiliency, problem solving, hopefulness, life purpose, educational attainment and perception of past, future and
                 present
                Section 4: Perceived Community capital – considers how conducive ones community is to recovery; experience of
                 stigma, crime, how accepted and supported one feels within their community and how comfortable or threatened
                 they feel invariably impacts on how an individual recovers with the support or otherwise from their community

   The ADP recognises that recovery journeys are non-linear, and whilst the aim is to enhance continual growth and
    improved functioning, there is also the potential for setbacks as part of the natural recovery process. Services will aim
    to foster resilience for all individuals and families for them to engage with their community assets.

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o As part of ongoing support, services will offer/ undertake regular recovery management check-ups in order to establish
        the status of an individual’s recovery, and where there are additional support needs this can be managed in a timeous
        manner with earlier re-entry to treatment.
      o Closer working relationships between services, peers and communities of recovery will enhance the opportunities for re-
        referral and signposting should individuals require it throughout their recovery journey and experiences
      o In order to reduce disengagement, when people transfer between services, staff should ensure there are clear and
        agreed plans to facilitate effective transition.

8. Children Affected by Parental Substance Misuse (CAPSM) sub group

The CAPSM Group is a sub-group with dual reporting arrangements of the North Ayrshire ADP and the Child Protection Committee
(CPC), and links in with other strategic Community Planning groups, including Safer North Ayrshire Partnership, Violence Against
Women Partnership, and the Adult Support and Protection Committee.

The CAPSM sub group work to improve the quality and accessibility to services for Children and Young People who are at risk due
to the harmful effects of parental/ care giver alcohol and/or drug misuse.

The group is responsible for strengthening an understanding across agencies of the needs of children and young people affected
by parental substance misuse and to support partners in developing an effective inter-agency response to children and young
people affected by parental substance misuse.

Through diverse representation on the group this enhances communication links and of joint working between adult and children’s
services. All developments in this area are aligned with the wider Getting it Right for every Child (GIRFEC) change agenda
developments in North Ayrshire and that cognisance is taken of links to relevant strategies, including the Early Years Framework
and the Parenting and Family Support Strategy.

Getting Our Priorities Right (GOPR) first published in 2003 and updated in 2013 provides an operational context for staff working in
the field of addiction where they come into contact with children or staff working with children who come into contact with addiction
issues. The GOPR guidance has formed part of the local and regional child protection procedures and its recommendations and
procedures resulted in an extensive and wide reaching multi agency training programme.

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The GOPR policy and practice guideline for working with children and families affected by problem drug use acknowledged that not
all families affected by problem drug use will experience difficulties. However the exposure of children and young people to the
risks factors associated with parental substance misuse may have significant and damaging consequences. These can include
children and young people not reaching their full potential at school, taking on the role of caregiver to young siblings or parent(s),
being placed at physical risk, developing their own physical and mental health problems, including developing their own substance
misuse issues. This policy has since been expanded to include families affected by alcohol misuse.

ADP Sub Group (CAPSM) Strategic Priority areas: Prevention, Protection & Recovery
National Outcome(s):

   FAMILIES: Children and family members of people misusing alcohol and drugs are safe, well-supported and have improved
    life-chances: this will include reducing the risks and impact of drug and alcohol misuse on users’ children and other family
    members; supporting the social, educational and economic potential of children and other family members; and helping family
    members support the recovery of their parents, children and significant others.

Children affected by parental substance misuse have been specifically cited as a priority area in the drugs strategy, The Road to
Recovery (2008). The drugs strategy cites the role of adult services and outlines actions to improve identification, assessment,
recording and planning, and information sharing; to build the capacity, availability and quality of support services; and to strengthen
the consistency and effectiveness of immediate risk management.
National Indicator:                                     Baseline      Target        Annual performance review (brief summary)    Metric
                                                                                                                                 RAG
   Maternities with drug use                          82 (2011)        77

   Child protection with parental drug misuse         51 (2014)        48
   Child protection with parental drug or             77 (2014)        73
    alcohol misuse
   Child protection with parental alcohol             50 (2014)        47
    misuse

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*Whilst the desire is to reduce the number of children involved in child protection processes; should these numbers increase this could be
interpreted as improvements in assessment/ earlier identification, therefore reducing the risk and the provision of support to meet the needs of
the child

   The following activity will be delivered in order to contribute towards the above noted national outcome and indicators,
    consisting of-
       o The ADP will continue to fund the Integrated Addiction Services
       o Integrated Addiction Services will undertake a Parenting Capacity Assessment as part of initial assessment and linking
          those identified to engage in the Parenting Programme. A programme will be adapted and delivered to parents who do
          not currently have the fulltime care of their children
       o Integrated Addiction Services will engage in Child Protection Case Conferences and consideration of parental needs
          through completion of child protection assessments
       o Effective partnership working between Vulnerable Midwife team and Addiction Services
       o Children’s information will be recorded within the SAMS and CareFirst database and to be considered for service
          development
   Funding will continue for Children 1st Forward Steps programme, providing individual and group support to new parents
   Continue to fund the Specialist Midwife (Alcohol) post who will-
       o highlight the impact of alcohol during pregnancy
       o raise awareness of Fetal Alcohol Spectrum Disorder (FASD) through training and literature
       o support the Vulnerable Midwife Team
       o support Maternity staff in the delivery of Alcohol Brief Interventions
       o contribute to the Early Years Collaborative
       o Audit work looking at how many women continue to drink alcohol during pregnancy with data being used for improvement
          work
       o Maternal alcohol consumption to be highlighted on paediatric notes where this information is made available for children
          who require assessment for FAS
       o Establish a local pathway for the diagnosis of FAS

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   Engaging with and supporting the Carers and Young Carers service where parents/family members are impacted by drugs or
    alcohol
   Engaging with services who deliver home visits and family programmes
   Engaging with STRADA to deliver specific training programmes, including the two day CAPSM training
   Continue funding to the Rosemount service where they will engage in Children’s Units, delivery of family therapy sessions and
    parenting groups incorporating the ‘Angelus Foundation’ toolkit for supporting parents to generate discussions with their
    children; supporting links between children and adult services; signposting young people and parents to groups within the
    community
   Child protection statistics will be provided on a regular basis for services to consider developments and trends of individual risk
    factors for children placed on the child protection register, with a particular focus on parental drug misuse and parental alcohol
    use
   Review support to children where there has been a parental drug related death. Findings will be shared with the Drug Death
    Review Group
   Findings from the Dartington Research Unit, which will be presented in the summer of 2015, will be considered to inform the
    ADP’s approach, and engagement with education and relevant partners

   The ADP will deliver alcohol/ substance misuse awareness programmes within primary and secondary schools.
       o The RORY resource will be delivered within all primaries with ongoing evaluation
       o The SPICE resource will be delivered within secondary schools in conjunction with Campus Police Officers and
         Community Development
            o Where children is identified as being affected by parental substance misuse, the ADP will support the delivery of
                 the CHARLIE and Children Harmed by Alcohol Toolkit (CHAT) resources

          North Ayrshire ADP and North Ayrshire CPC have created 'A Practitioners Guide to Getting Our Priorities Right',
           Working with Children, Young People and Families affected by alcohol and/or drug use across North Ayrshire. The
           guidance has been developed in partnership across a wide range of services and/or agencies, who are working directly
           with children, young people and families affected by problematic alcohol and/or drug use. This practitioner’s guide is for

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all practitioners and managers working with children, young people and their families within the public, private and third
          sectors across North Ayrshire.

             o The CAPSM sub group members is responsible for the implementation and evaluation in how the resource is
               being utilised, highlighting practice developments
                   Staff training sessions will be delivered to raise awareness of GOPR practitioners guidance, with a specific
                     focus on enhancing partnership working, communication between children and adult services, and recovery
                     of children and parents

A comprehensive training calendar is delivered by the CPC and ADP. The nature of training is incorporated within the ADP
Harmonised Framework. Further details can be found within the Workforce Development sub group section.

9. The ADP Communities & Prevention sub group (CPG)

The CPG ensure that a whole population approach to prevention and education and early intervention takes place. They provide
regular update reports to North Ayrshire ADP and Safer North Ayrshire Partnership (SNAP) highlighting areas for consideration or
action as appropriate.

Education is an important tool for increasing the awareness of the effects of alcohol and drug use on individuals, families and
communities, and the risks associated with even low levels of alcohol or drug use.

The inclusion of substance misuse in the Curriculum for Excellence is a positive step toward ensuring that all young people in North
Ayrshire are aware of the risks associated with alcohol and drug use. However it is recognised in both the Curriculum for
Excellence and wider literature that preventative information should be delivered to young people in a range of settings and formats
in order to reinforce messages delivered in educational establishments.

Prevention of substance misuse through education is not only important for young people, we recognise the importance of
educating the wider adult population on the risks of substance use, in particular alcohol use. This is achieved through the delivery
of targeted, audience appropriate messages within formal and community settings.

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The availability of positive alternatives to alcohol and drug use is essential to reduce the level of substance use. Age appropriate
activities including diversionary activities for young people and an increase in non-alcohol activities for adults will contribute to a
reduction in alcohol consumption.

Domestic abuse is a major problem within North Ayrshire. While we recognise that alcohol is neither an excuse for, nor a cause of,
domestic abuse it is a significant factor in incidents reported to the Police. The ADP work alongside the Violence against Women
Partnership, to reduce the harmful impact of alcohol in cases of domestic abuse, providing opportunities for both perpetrators and
victims to address their alcohol and drug misuse.

A key part of work within communities is to improve the knowledge and understanding across the whole population about drug and
alcohol use. The ADP also demonstrates that recovery is possible through positively promoting recovery stories and reduces the
levels of fear, blame and stigma.

The significant links between alcohol and drug misuse and offending behaviour are well recognised. In North Ayrshire
approximately 70-80% of service users in Criminal Justice Social Work have a background of alcohol and drugs use linked to their
offending behaviour.

North Ayrshire ADP and the SNAP will continue to plan and work in partnership around the issues of anti-social behaviour and
nuisance as a consequence of alcohol and /or drug misuse.

ADP Sub Group (CPG) Strategic Priority: Prevention; Protection & Communities
National Outcome(s):

   HEALTH: People are healthier and experience fewer risks as a result of alcohol and drug use: a range of improvements to
    physical and mental health, as well wider well-being, should be experienced by individuals and communities where harmful drug
    and alcohol use is being reduced, including fewer acute and long-term risks to physical and mental health, and a reduced risk of
    drug or alcohol-related mortality.

   PREVALENCE: Fewer adults and children are drinking or using drugs at levels or patterns that are damaging to themselves or
    others: a reduction in the prevalence of harmful levels of drug and alcohol use as a result of prevention, changing social
    attitudes, and recovery is a vital intermediate outcome in delivering improved long-term health, social and economic outcomes.
    Reducing the number of young people misusing alcohol and drugs will also reduce health risks, improve life-chances and may

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reduce the likelihood of individuals developing problematic use in the future.

   COMMUNITY SAFETY: Communities and individuals are safe from alcohol and drug related offending and anti-social
    behaviour: reducing alcohol and drug-related offending, re-offending and anti-social behaviour, including violence, acquisitive
    crime, drug-dealing and driving while intoxicated, will make a positive contribution in ensuring safer, stronger, happier and more
    resilient communities.

   LOCAL ENVIRONMENT: People live in positive, health-promoting local environments where alcohol and drugs are less readily
    available: alcohol and drug misuse is less likely to develop and recovery from problematic use is more likely to be successful in
    strong, resilient communities where healthy lifestyles and wider well-being are promoted, where there are opportunities to
    participate in meaningful activities, and where alcohol and drugs are less readily available. Recovery will not be stigmatised, but
    supported and championed in the community.

Ministerial Priorities

   Increasing the reach and coverage of the national naloxone programme by increasing the number of kits supplied to people at
    risk of opiate overdose
   Developing local understandings of the prevalence and impact of new psychoactive substances in ADP areas based on locally
    available information and experience.
   Deliver Alcohol Brief Interventions

2015/16 SOA- People are healthier and experience fewer risks as a result of alcohol and drug use
 Reduction in the number of Drug Related Deaths

National Indicators:                                        Baseline          Target        Annual performance review (brief   Metric
                                                                                                       summary)                RAG
   Drug related hospital stays                           290 (2013)        280
   Alcohol related hospital stays                        1208 (2013)       1156
   Drug-related mortality                                11 (2013)         11
   Alcohol related mortality                             23 (2013)         21
   Hepatitis C among people who inject drugs             22 (2011)         21
   Population prevalence of problem drug use             1800 (2012)       1710

                                                                                                                                        25
   Drug use last month (pupils age 15)                 45 (2013)         42
   Drug use last year (pupils age 15)                  74 (2013)         70
   Weekly drinkers (pupils age 15)                     60 (2013)         57
   Drug use funded by crime                            51 (2011)         48
   Serious assault (alcohol)                           100 (2012)        94
   Common assault (alcohol)                            1551 (2012)       1500
   Vandalism (alcohol)                                 1905 (2012)       1840
   Breach of the Peace (alcohol)                       490 (2012)        462
   Pupils age 15 being offered drugs                   151 (2013)        142
   Perception of drug misuse in neighbourhood          30 (2013)         28
   % people perceiving rowdy behaviour (alcohol)       33 (2013)         31
   Licenses in force-
       o on trade                                       281 (2013)        281
       o off trade                                      120 (2013)        120
   Personal licenses in force                          1515 (2013)       1515

   Increasing the reach and coverage of the national naloxone programme by increasing the number of kits supplied to
    people at risk of opiate overdose will be achieved through the following activity-

       o The ADP will continue to deliver the Take Home Naloxone programme and Training 4 Trainers (T4T) to a diverse range
         of staff disciplines, family members and people in recovery;
       o The T4T will be offered to community and prison peer mentors;
       o Naloxone will be discussed, and offered at point of assessment, for any service user advising of association with opiates;
       o Reviewing homeless housing policy in the storage of naloxone within residential settings
       o Promoting the World Overdose Day and naloxone literature

   Developing local understandings of the prevalence and impact of new psychoactive substances (NPS) in ADP areas,
    based on locally available information and experience, will be achieved through-

                                                                                                                                 26
o   Ongoing delivery of NPS training to a diverse range of service providers
       o   An annual report will be circulated in respect of NPS training, highlighting learning and developments
       o   Working in partnership with Scottish Families Affected by Alcohol and Drugs (SFAD)
       o   Engagement on the National Expert Review Group on NPS and to adopt findings
       o   Services to gather and record information at point of assessment
       o   Delivery of the pan Ayrshire Drug Trend Monitoring Group, with dissemination of a quarterly bulletin highlighting trends
       o   Collate information within the drug trend monitoring template for wider circulation
       o   NPS awareness sessions delivered within secondary schools, incorporated within the Substance Prevention in
           Community Education (SPICE) resource, and utilising Campus Police Officers to promote
       o   NPS resources circulated within the ADP network and incorporated within ADP website
       o   NPS workshops delivered within Ayrshire College
       o   Consider and respond to the sale of NPS through engagement with Trading Standards and Police Scotland
       o   The delivery of awareness raising campaigns to a range of stakeholders

   The following activity will be delivered in order to contribute towards the above noted national outcomes, consisting
    of-

           o The inclusion of alcohol/ substance misuse awareness programmes within primary and secondary schools.
                 The RORY resource will be delivered within all primaries with ongoing evaluation
                 The SPICE resource will be delivered within secondary schools in conjunction with Campus Police Officers and
                   Community Development
                 Delivery of the Jump2It basketball initiative in primary schools
                 Fire School Liaison Officers will deliver a series of presentations as part of the Fire Safety for Schools
                   Programme, in which the correlation between drugs and alcohol, particularly when cooking are covered.
                 Firereach courses will be delivered to secondary schools highlighting the relationship between fire risk/road
                   traffic collisions and alcohol/drug use.

           o Findings from the Dartington Research Unit will be considered to inform the ADP’s approach, and engagement with
             education and relevant partners. One of the key risk factors identified is the early initiation of substance use
           o Test purchasing operations will take place within off sales

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o Engaging with STREETWISE, a partnership involving local young people, Modern Apprentices, North Ayrshire
         Council Youth Services and Police Scotland with support from other partners including the NHS
       o Engagement with higher threshold young people through continued funding for Rosemount and Programmes
         Approach Team
       o Engaging with accommodated young people and those within homeless settings
       o Engaging with parents of young people to raise awareness of programmes taking place and to raise their confidence
         in discussing subject matter
       o Support effective pathways and ongoing support for young people who has presented at A&E with alcohol/drug
         related issues
       o Prevalence study being undertaken between Ayrshire College and Scottish Families Affected by Alcohol and Drug
         Use to Ayrshire College students. Study aims to find out the harms caused to students by someone else’s alcohol or
         drug use, and a prevalence question about students’ own alcohol and/or drug use included.
       o Formal partnership with Alcohol Focus Scotland to consider the impact of alcohol use within communities and
         methods being identified to address these matters
       o Delivery of Alcohol Brief Interventions within priority and non-priority settings
       o Engagement with the Adult Support and Protection committee

   The reduction of Blood Borne Viruses (BBV) and Sexually Transmitted Infections (STI) will be achieved through-
    o The provision of a range of needle exchange sites
    o The offer of BBV and sexual health testing during initial assessments and review meetings
    o Support being provided to individuals undertaking BBV related treatment
    o Delivery of Hepatitis C support groups
    o Engagement between the ADP and BBV Managed Care Network, identifying partnership working and joint
       commissioning
    o The delivery of BBV training through the addiction calendar and Ayrshire College
    o Promotion of World Aids Day and World Hepatitis Day
    o Health literature located within a number of settings
    o Promotion of C-Card venues

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